Author Topic: The best ankle splint for really bad fractures...  (Read 4358 times)

Offline Asclepius

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The best ankle splint for really bad fractures...
« on: March 15, 2010, 09:39:27 PM »
...is a pillow folded around the back of the ankle and taped in front, or a blanket rolled up as a scroll on both sides of the ankle from behind and taped in the front.

Cardboard splints and sam splints just never seem to work for this bony part of the body.

Offline Doc K

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Re: The best ankle splint for really bad fractures...
« Reply #1 on: March 16, 2010, 05:01:25 AM »
I think the pillow will work (and has many times).

But I prefer 2 SAM Splints put on like this: http://www.sammedical.com/videos/anklestirrupand.html

Doc K

Son_of_the_Republic

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Re: The best ankle splint for really bad fractures...
« Reply #2 on: March 16, 2010, 07:16:39 AM »
Nicely done

Offline Asclepius

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Re: The best ankle splint for really bad fractures...
« Reply #3 on: March 17, 2010, 05:21:29 PM »
I think the pillow will work (and has many times).

But I prefer 2 SAM Splints put on like this: http://www.sammedical.com/videos/anklestirrupand.html

Doc K

Cool. I've done the figure 8 with the SAM but never have combined it with a stirrup. I will try that next time and see if I can make it work. Is the idea to have them walk on that?

Offline Doc K

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Re: The best ankle splint for really bad fractures...
« Reply #4 on: March 17, 2010, 07:36:49 PM »
Is the idea to have them walk on that?

I don't think so... I don't think it would be the same as something like a CAM walker, but I have never tried it.
I think it would depend on the extent of the injury.

Doc K

Offline PositiveForce

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Re: The best ankle splint for really bad fractures...
« Reply #5 on: March 18, 2010, 05:39:46 PM »
Also, ice that ankle ASAP!! Ice will bring that swelling down. As a combat medic, I always stuffed those cold compresses that you crack and shake in my aid bag.

Great tips on the splints BTW!

Offline DeltaEchoVictor

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Re: The best ankle splint for really bad fractures...
« Reply #6 on: March 18, 2010, 10:29:05 PM »
I've used the pillow many times & the sam too. 

Having been through a pretty devastating ankle injury myself & an extended transport, I'm not sure I could have stood having the sam against my mangled anatomy like that.  The pillow wasn't bad as it offered some cushion, as a result I tend to lean toward the pillow.

I'm not making the argument against the sam & figure of eight, just saying the pillow seemed the right thing at the right time.

Offline Blu

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Re: The best ankle splint for really bad fractures...
« Reply #7 on: March 18, 2010, 11:15:58 PM »
also make sure you check the pulse downstream before you splint and after so that you do not cut off circulation.  With the bones in odd places it can cut it off rather quickly if you start putting pressure with the ACE.

Offline Asclepius

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Re: The best ankle splint for really bad fractures...
« Reply #8 on: March 19, 2010, 11:26:09 PM »
also make sure you check the pulse downstream before you splint and after so that you do not cut off circulation.  With the bones in odd places it can cut it off rather quickly if you start putting pressure with the ACE.

What am I supposed to do differently to the ankle if I don't find a pulse?

Offline patientliberty

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Re: The best ankle splint for really bad fractures...
« Reply #9 on: March 27, 2010, 07:20:11 PM »
The dorsalis pedis pulse is found in a line drawn from the junction (bases) of the first (great) and second toes, moving back towards the ankle about 4 fingerbreadths (proximal - towards the ankle; distal - towards the toes).

The other palpable pulse in the foot/ankle is the posterior tibialis pulse, just behind the medial malleolus (the tibia), on the "inside" (big toe side, or medial side) of the ankle.

If someone has an ankle that looks broken (bruising, swelling, excruciating pain), here is what doctors do in the ER to preserve the blood supply of the foot:

1) make the deformity worse
2) pull the foot distally (see above = towards the toes)
3) correct the deformity
4) apply a well-padded splint
5) make sure the pulse has returned

You can make things worse by doing this; think about convincing a judge that you truly believed there was no blood flow in that foot before you "treated" this person...

PL

Offline Asclepius

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Re: The best ankle splint for really bad fractures...
« Reply #10 on: March 29, 2010, 08:45:11 PM »
Doctors in the ER take an x-ray first.

I have straightened long-bones, but I probably will not try it with an ankle. There are so many hidden structures that I am not confident that I wouldn't make things worse. I think I would focus my efforts on splinting and evac.

Offline patientliberty

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Re: The best ankle splint for really bad fractures...
« Reply #11 on: March 29, 2010, 09:13:42 PM »
Quote
Doctors in the ER take an x-ray first.

ER doctors may do this, and most do. Orthopaedic surgeons do not take x-rays first (in the ER).

This is a bad situation and in fact is one of the few true orthopaedic emergencies:

1) compartment syndrome
2) open fracture
3) blood flow compromise
4) dislocated joint

It's a rock and hard place situation for first responders. The orthopaedic surgeon rolls his eyes when he sees the x-ray showing the dislocated/badly displaced ankle fracture (that you can see across the room in the ER), but that same surgeon's eyes would bug out if EMTs started straightening out all deformities they came across.

Anyway, it's fun to discuss it, at least anatomically. For instance, the longer a blood vessel is kinked over a sharp fracture edge, the more likely it will be to clot and be permanently injured, requiring surgery to repair. Whereas, if the ankle is straightened, the vessel unkinked, and blood flow restored (even though other structures may not be perfectly aligned), you buy lots of time.

PL


Offline benjaminbrasel

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Re: The best ankle splint for really bad fractures...
« Reply #12 on: April 25, 2010, 03:48:37 PM »
SAM SPLINTS all the way!!!!!!!!!! You can cut or mold them in any shape you need. You can even use them as a c-collar in a pinch.